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General NPI Number Information
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NPI Number | 1407370117
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Entity Type | Organization
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Legal Business Name | AGINCARE HOMECARE SERVICES, INC.
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Dates
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Enumeration Date | 08/03/2017
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Last Update Date | 08/03/2017
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Provider Practice Location Address
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Address Line | 17561 HILLSIDE AVE STE 403
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City | JAMAICA
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State | NY
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Zip | 11432-5769
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Country | US
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Telephone | 973-868-1962
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Fax |
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Provider Business Mailing Address
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Address Line | 17561 HILLSIDE AVE STE 403
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City | JAMAICA
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State | NY
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Zip | 11432-5769
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | COO
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Name | MR. MURRAY WILLIAMS
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Credential |
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Telephone | 973-868-1962
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 2191L001
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License Number State | NY
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